Postvaricella angiopathy: Report of a case with pathologic correlation

Varicella is a common childhood illness, and central nervous system complic ations occur frequently. Delayed angiopathy has been described, although th ere are few reports of clinicopathologic correlation. A previously well 4-y ear-old male is presented. He suffered varicella 2 months before presentati on with extensive right middle cerebral artery (MCA) territory infarction, Cerebral angiography demonstrated an isolated 89% stenosis of the right pro ximal MCA. He developed cerebral edema refractory to medical treatment and progressed to transtentorial herniation, Right frontal temporoparietal cran iotomies were performed with evacuation of infarcted brain tissue. Patholog ic studies revealed small vessel vasculitis with lymphocytic infiltration o f the vessel wall. Areas of demyelination were present within the white mat ter. Polymerase chain reaction for varicella was negative on brain tissue. Postvaricella angiopathy, although an uncommon complication, may affect bot h small and large blood vessels, with catastrophic results. (C) 2001 by Els evier Science Inc. All rights reserved.